    [Public Papers of the Presidents of the United States: George W. Bush (2004, Book III)]
    [October 21, 2004]
    [Pages 2631-2639]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in Downingtown, Pennsylvania
    October 21, 2004

        The President. Thank you all for coming. I appreciate you all being
    here. Thanks for coming. Thanks for coming. I appreciate such a warm
    welcome. I'm proud to be back in Chester County, Pennsylvania. I'm here
    to ask for your help. We're less than two weeks away, when the people
    get to go express their opinion in the polls. And I believe with your
    help, we're going to win the State of Pennsylvania.
        I know a lot of people are working hard in this campaign, and I am
    here to thank you. I want to thank you for putting up the signs. I want
    to thank you for making the phone calls. I want to thank you for
    reminding our fellow citizens we have a duty to go to the polls in a
    democracy. And when you get them headed to the polls, remind them if
    they want a safer America, a stronger America, and a better America, to
    put me and Dick Cheney back in office.
        So ever since Barbara and Jenna were young, I've been telling them we're going to go on
    the great family camping trip. [Laughter] I'm sure they envisioned the
    Colorado River or the wilds of Alaska, but no, the great family camping
    trip turned out to be the campaign of 2004. And I can't tell you--I
    cannot tell you how great it is to have my daughter introduce me in
    front of you all. I'm proud of Barbara. I love her dearly. And I thank
    you for joining me, darling.
        My only regret, which is I'm sure your regret, is that Laura is not here--and Jenna, of
    course, but she's with Laura. See, when I asked Laura to marry me, she
    said, ``Fine, I will marry you, so long as I never have to give a
    speech.'' [Laughter] I said, ``Okay, you've got a deal.'' Fortunately,
    she did not hold me to that deal. Laura is giving a lot of speeches, and
    when she does, the American people see a warm, compassionate, strong
    First Lady.

    [[Page 2632]]

        Audience members. Four more years! Four more years! Four more years!
        The President. Thank you all.
        I am proud of my runningmate. I met with the
    Vice President this morning at our national security briefing. It--
    taking a look at him reminded me I didn't pick him because of his
    hairdo. [Laughter] He does not have the waviest hair in the race.
    [Laughter] But I picked him because of his experience and sound
    judgment. He's doing a great job for the American people.
        By the way, a fellow you trained is doing a great job in Washington,
    and that would be your former Governor, Tom Ridge.
    He is a fine member of a very strong Cabinet. And he is doing a fine job
    of helping protect this homeland.
        I want to thank your two United States Senators for their service to
    your State. First, I hope you put Arlen Specter back into office. He's a good Senator. And I'm proud to
    work with your other Senator, Rick Santorum.
        I want to thank Congressman Jim Gerlach for
    his service to this district. I appreciate you, Congressman. He's
    somewhere around here. Where--there you are, Congressman. Good to see
    you. I see you're sitting next to a good fellow in Congressman
    Joe Pitts--appreciate you coming, Joe. And
    Congressman Tom Feeney from the State of Florida
    is with us. Feeney--yes, what are you doing here? Get back to your
    district and turn out the vote. [Laughter] I'll see you down there
    Saturday. [Laughter]
        I want to thank all the local folks who are here. I want to thank my
    friend Alan Novak, who is the party chairman. I
    want to thank--[applause].
        Barbara and I just had a chance to meet
    with four doctors from the area and a patient, Charlene Ware. And the docs were all telling me you got a problem
    here. We're going to talk about health care here today. I want to thank
    the docs for taking time to visit with me to share their concerns. And
    part of my address today is to share their concerns with you, because in
    order to make sure we've got a good health care system, we've got to
    make sure you have good professionals remain right here in your
    neighborhood to help solve the problems you have.
        We have a lot at stake in this election. There are big issues that
    we're discussing. When I ran for President 4 years ago, none of us could
    have ever envisioned the horror of September the 11th. Since that day, I
    have led a comprehensive strategy to defeat the terrorists, to keep the
    homeland safe and secure. I pledged to the American people, we would be
    resolute and determined and do our duty to protect you, and I kept my
    pledge.
        Our economy has been through a lot. When you're out rounding up the
    vote, remind people about what we have been through. The stock market
    was in serious decline 6 months prior to my arrival in Washington, DC.
    And then we went through a recession. We had some corporate scandals. We
    passed tough laws, by the way. We have made it abundantly clear we will
    not tolerate dishonesty in the board rooms of America. And then we got
    attacked. It cost us about a million jobs in the 3 months after
    September the 11th. I pledged to the American people, we would reduce
    your taxes to get our economy going again. I kept my word. Our economy
    is strong, and it is getting stronger.
        I promised to reform our public schools and to challenge the soft
    bigotry of low expectations. I kept my word. We passed the No Child Left
    Behind Act, and we're closing an achievement gap all across America. And
    we're not going to go back to the days of mediocrity and low standards.
        Another major area that needs reform is health care. We have made a
    good start. And in a new term, I will build on our efforts to improve
    America's health care. Health care is an essential issue in this
    campaign. And it's an essential issue in

    [[Page 2633]]

    Pennsylvania, and that's why I'm delighted to come here to talk about
    it.
        Across America, small-business owners are struggling with the high
    cost of providing health insurance for their employees. Some workers
    have lost good coverage because they have changed jobs. Women have lost
    doctors they trust because of frivolous lawsuits. We need to act on
    these concerns. And we need to act in a practical, responsible way.
        Here, America faces a clear choice. When it comes to health care,
    Senator Kerry's prescription is bigger
    Government with higher costs. My reforms will lower costs and give more
    control and choices to the American people.
        The United States of America has a world-class health care system
    that leads the world in providing amazing treatments and cures for
    millions of people. As a candidate for President, I had pledged to
    double the budget of the National Institutes of Health to make sure we
    stay on the leading edge of change and reform. I kept my word. We have
    the most advanced hospitals in the world who do the most innovative
    research. We have the finest, most highly trained health care
    professionals in the world. We lead the world because we believe in a
    system of private medicine that encourages innovation and change.
        Yet, rising costs and changes in the way Americans live and work are
    putting affordable health care out of the reach of too many of our
    citizens. Today I want to talk about a commonsense way to make health
    care more affordable and accessible while preserving America's system of
    private medicine.
        Our reforms will help our families and individuals afford health
    insurance and save for health care expenses. They will help more small
    businesses provide health care coverage for their employees. And that's
    important, because more than one-half of the uninsured working Americans
    work for small businesses. My reforms will make sure low-income
    Americans, especially children, get the health care they need. They will
    ensure preventative care and prescription drug coverage for our seniors
    on Medicare and provide quality health care for our Nation's veterans.
    And my reforms address the root causes of rising health care costs,
    which make health care more expensive for everyone.
        In a new term, we'll take five practical steps to make health care
    more affordable and accessible in America. And here they are.
        First, we'll expand health savings accounts or HSAs. An HSA is an
    innovative approach to health care that gives you affordable coverage
    for major illness and allows you to save money, tax-free, up to a set
    limit to use for routine medical expenses. You can make a contribution
    to this account; your government can make a contribution to the account;
    or your employer can make a contribution to the account. If you don't
    use all the money in a year, you can roll it over, tax-free, to meet
    future expenses.
        Health savings accounts protect you against catastrophic medical
    expenses. Because you can take your savings account from job to job, it
    provides you more security if you change jobs. This approach will help
    our Nation confront the rising cost of health care, and this is how.
        One of the reasons why health care costs are on the rise is that
    consumers are not involved in the decisionmaking process. Most health
    care costs are covered by third parties, and therefore, the user of
    health care is really not the purchaser of health care. With HSAs, we
    introduce market forces. It means you can shop around for the health
    care that's best for you. It means you'll be able to get better health
    care at better prices, because you're the decisionmaker.
        To help more people own HSAs, I proposed allowing individuals to
    deduct the cost of their insurance premiums from their

    [[Page 2634]]

    taxes. To help employers cover more workers, I proposed tax credits for
    small businesses to pay into HSAs for their employees. To help the
    uninsured, I proposed a $3,000 refundable tax credit to help low-income
    families buy their own HSAs. These incentives will allow many more of
    our fellow citizens to have a health care account that they manage and
    that they call their own.
        To help people afford health care, we will pass association health
    plans, which allows small firms to join together, to pool risk so they
    can buy insurance at the same discounts big companies are able to do.
    That means a stand-alone family restaurant in Pennsylvania can join
    together with other small restaurants all around the country so they can
    spread the risk, so they don't have to buy insurance in the market as a
    stand-alone entity. This is a practical way to enable small businesses
    to better afford health care for their employees.
        I view a health savings account or an association health plan as
    commonsense ideas. It makes sense. Yet my opponent is against both of
    them. He doesn't agree. And there's a reason why. Senator Kerry's idea of reform always involves bigger and more
    intrusive Government.
        Audience members. Boo-o-o!
        The President. And his health care proposal proves my point. In one
    of our debates, Senator Kerry looked into the
    television camera with a straight face and said, quote, ``Government has
    nothing to do with it.'' That was in reference to his health care plan.
    I could barely contain myself. In fact, Government has a whole lot to do
    with his plan, and that's important for you to know. Senator Kerry's
    proposal would expand the Government health care rolls by nearly 22
    million Americans. That would be the largest expansion of Government
    health care in American history. Eight out of ten people who get health
    coverage under his plan would be placed on a Government program.
        He would make Medicaid a large--a program
    so large that employers would have the incentive to drop private
    coverage so the Government would pick up the insurance tab for their
    employees. Now, think about that. When you make Medicaid more
    accessible, the small business will have the incentive to say, ``Well,
    the Government will provide the insurance, so I don't have to.'' That's
    why I say that some 8 million Americans will go from private insurance
    to Government-run insurance. And Medicaid is a Government-run program.
        The Senator wants the Federal Government
    to pick up the tab for large medical bills that private employer-
    sponsored plans now pay for. In other words, the Federal Government is
    going to become like an insurance company, a re-insurer, which sounds
    fine on the surface except remember this, when the Federal Government
    writes the check, the Federal Government also writes the rules. And when
    the Federal Government starts to write the rules, the Government decides
    who's covered and who gets the coverage and how much care you get.
        In addition, an independent study estimates that John Kerry's plan would impose at least 225 new regulatory
    mandates on small businesses. One group looked at the plan and described
    it as an overpriced albatross. [Laughter] That's being kind. [Laughter]
    This is a plan that will create burdens that our job creators cannot
    afford and do not deserve.
        And the plan costs a lot: $1.2 trillion. That's with a ``T.'' That's
    a lot. [Laughter] And he says, ``Oh, don't
    worry, I'm going to pay for it all by taxing the rich.'' You can't raise
    enough money by taxing the rich to pay for a $1.2 trillion health care
    plan. Matter of fact, if you run up the top two brackets, it raises
    between 600 billion and 800 billion dollars, so there is a gap between
    what he promises and how he says he's going to pay for it. And guess who
    usually fills the gap? Yes, you do.

    [[Page 2635]]

        There's also something else wrong with saying ``to tax the rich.''
    The rich hire lawyers and accountants for a reason: to slip the tab to
    you. We're not going to let him tax you; we're
    going to carry Pennsylvania on November the 2d.
        Audience members. Four more years! Four more years! Four more years!
        The President. Thank you all.
        When you're out there campaigning and rounding up the vote, remind
    people about the facts of his plan. The Kerry
    plan would move America down the road toward Federal control of health
    care, which would lead to lower quality and health-care rationing. Other
    countries have tried centralized health care, and it didn't work. We
    have great quality health care in America because it is a private-center
    system. And I intend to keep it that way. Health care decisions ought to
    be between doctors and patients, not by officials in Washington, DC.
        Third, we must fix our broken legal system. Junk lawsuits are
    expensive for doctors and hospitals to fight in court. They are
    expensive to settle out of court. They drive up the cost of liability
    insurance for every doctor, and they increase the cost of health care
    for all Americans.
        To avoid junk lawsuits, many doctors practice defensive medicine.
    They order tests and write prescriptions that aren't really necessary
    just to protect themselves from lawsuits. That's what happens in a
    society that has too many lawsuits. The practice of defensive medicine
    raises costs for patients and small businesses and adds about $28
    billion a year to the Federal budget. Remember, the Federal budget takes
    care of Medicare and Medicaid and veterans, and the practice of
    defensive medicine runs up the cost to the Federal Government, which
    really runs up your tab. See, you pay for it. When we're talking about
    the Government's money, we're really talking about your money. We want
    our doctors focused on fighting illness, not on having to fight
    lawsuits.
        The effects of the litigation culture are real in the State of
    Pennsylvania. They are hurting the quality of life in this State.
    Medical liability premiums are skyrocketing in this State, as they are
    in other States. For specialists in high-risk fields like ob-gyn, those
    premiums have doubled or tripled in some counties since 2000. And guess
    what happens? Docs leave the practice of medicine.
        In the past 2 years, Mercy and Methodist Hospitals in Philadelphia
    both stopped delivering babies. The quality of life is deteriorating
    because of these lawsuits. Brandywine's only trauma center was forced to
    close. The quality of life is deteriorating because of these junk
    lawsuits. According to a recent poll, one in four people in Pennsylvania
    have been forced to change doctors in the last year because liability
    costs have forced their doctor to move, to stop practicing, or to
    discontinue procedures. And every time a good doctor is forced out of a
    community by lawsuits or the fear of lawsuits, the quality of life
    deteriorates.
        Not long ago, I met Mary Coar from Honesdale.
    Her ob-gyn had to give up delivering babies because of liability
    concerns. When Mary was 4 months pregnant, she started driving 50 miles
    each way to see a different doctor. When Mary's daughter arrived this
    summer, she was delivered by a doctor she had never met. When a mother
    is looking forward to having a baby, the last thing she needs is
    uncertainty about her health care. For the sake of women and families
    across this State and this country, we need medical liability reform.
        The difference between my opponent's point
    of view and mine is very clear on this issue. He has voted 10 times
    against medical liability reform during his Senate career. This year,
    when the Senate considered bills to protect ob-gyns and trauma
    physicians, Senator Kerry opposed them. Now, I
    know we're in a campaign, and he's paying lip service to legal reform.
    But it's his votes and his actions, not his words,

    [[Page 2636]]

    that really count. He can run from his record, but he cannot hide.
        In a new term, we'll pass real caps on noneconomic damages. This is
    a national problem requiring a national solution. And I will lead the
    United States Congress to pass medical liability reform.
        Fourth, we'll reduce health care costs by applying modern
    information technology to our medical system. Many doctors' offices
    practice 21st century medicine; many hospitals practice 21st century
    medicine but still have 19th century filing systems. And in hospitals,
    there's more risk of medical error when all the records are handwritten
    on paper instead of cross-checked on a computer. That makes sense.
    Doctors don't write very well, anyway. [Laughter] They write about as
    well as I speak English. [Laughter]
        The current system is costly and is wasteful and sometimes
    horrible--sometimes harmful. And we're on our way to fixing it. I've set
    a goal to make electronic medical records available for most Americans
    within the next decade. We're working with States and private hospitals
    to set standards for information storage and sharing. When the health
    care community fully maximizes the use of information technology, we
    will reduce medical costs by as much as 20 percent. We will cut medical
    errors, and we will save lives.
        Fifth, we're cutting health care costs by moving cheaper generic
    drugs to the market faster. My administration is making sure that drug
    companies do not use delaying tactics to keep cheaper generic
    equivalents from getting to the consumers. Our actions will save
    Americans at least $35 billion on the medicine over the next 10 years.
    And that will make lifesaving drugs more affordable to our seniors.
        As we move forward and make health care more affordable and
    accessible, we'll also keep the commitments we've made, commitments
    necessary for a compassionate country. We have strengthened and
    modernized Medicare. I told the American people we had a problem with
    Medicare when I was campaigning. I brought Republicans and Democrats
    together, and I kept my word in modernizing Medicare.
        Listen, Medicare would pay thousands of dollars for a heart surgery
    but not one dime for the prescription drug that could prevent the heart
    surgery from being needed in the first place. It didn't make any sense.
    And so we've strengthened and modernized Medicare. I signed a bill to
    strengthen the system. Now seniors are getting discounts on their
    medicine with drug discount cards. And low-income seniors are getting
    $600 worth of help a year to buy those medicines. And beginning in 2006,
    all seniors will be able to get prescription drug coverage under
    Medicare.
        We have another difference of opinion on this issue. My
    opponent voted against the Medicare bill that
    included prescription drug coverage for seniors, even though that bill
    was supported by AARP and other seniors' groups. Later, he said, quote,
    ``If I'm the President, we're going to repeal that phony bill.'' Then he
    said--then he said a little later----
        Audience members. Boo-o-o!
        The President. ----``No, I don't want to repeal it.'' That sounds
    familiar.
        Audience members. Flip-flop! Flip-flop! Flip-flop!
        The President. As President for the next 4 years, I will defend the
    reforms we have worked so hard to pass so we can keep the promise to our
    seniors.
        We'll keep our commitment to America's children by helping them get
    a healthy start in life. I'll work with Governors and community leaders
    and religious leaders to make sure every eligible child is enrolled in
    our Government's low-income health insurance program. We will not allow
    a lack of attention or information to stand between millions of children
    and the health care they need.
        I know some of you here are worried about the upcoming flu season. I
    want to assure our seniors and families with young

    [[Page 2637]]

    children that our Government is doing everything possible to help
    seniors and children get their shots, despite the major manufacturing
    defect that has caused this problem. We have millions of vaccine doses
    on hand, and millions more will be shipped in the coming weeks. We're
    working closely with State and local officials to get the flu vaccine to
    the most vulnerable Americans throughout our country. If you're feeling
    healthy, like I'm feeling healthy these days, don't get in line for the
    flu shot.
        To make sure health care is available, we will keep our commitment
    to low-income Americans by expanding America's community health centers.
    Community health centers take the pressure off of local emergency rooms,
    improve care for the needy, and lower costs for us all. Since I took
    office, we have opened or expanded more than 600 community health
    centers. In a new term, we'll open or expand 600 more and bring healing
    to areas with the greatest need. Every poor county in America should
    have a rural or community health center.
        And finally, we will keep our commitment to American veterans who
    have served our country so well. We have increased spending for the
    veterans during my time by $22 billion, which is double the amount my
    predecessor did in the 8 years he served
    as President of the United States. We're reducing the backlog in
    veterans' health care claims. We're modernizing our VA health centers
    and building new ones. Men and women who wore this Nation's uniform
    deserve first-class medical care, and we are getting the job done.
        Health care is one of the most important issues facing our country.
    I'm glad you came today to let me talk about it. I'm passionate in
    understanding there is a right way to make sure health care is available
    and affordable and a wrong way. I feel strongly that the way I have
    proposed is the right way for Americans.
        There is a big difference of philosophy in this campaign. If you
    think about it, on issue after issue after issue, my opponent wants the Government to dictate to the American
    people. I want the American people to decide. He trusts Government; I
    trust the people.
        I'm ready for the work ahead. I know what we need to do to make sure
    this country is a more hopeful country and a more secure country. I've
    set out a set of clear priorities based upon a political philosophy that
    says Government will help people realize their dreams, not tell them how
    to live their lives.
        We'll move forward on a health care system that makes sure we got
    the best health care system in the world, a health care system where the
    decisions will be made by doctors and patients, not by officials in our
    Nation's Capital. We'll continue to promote excellence in every public
    school, so no child is left behind. I'll continue to promote a pro-
    growth, pro-entrepreneur, pro-small-business, pro-farmer economic agenda
    so people can find work.
        But all progress ultimately depends on the security of our Nation.
    We're in the middle of a global war on terror. We face an enemy that is
    determined to kill the innocent and convert our country into a
    battlefield. In this war on terror, there is no place for confusion, no
    substitute for victory.
        Audience members. Four more years! Four more years! Four more years!
        The President. The most solemn duty of the American President is to
    protect the American people. If America shows uncertainty or weakness in
    this decade, the world will drift toward tragedy. This will not happen
    on my watch.
        Since that terrible morning of September the 11th, 2001, we've
    fought the terrorists across the Earth, not for pride, not for power,
    but because the lives of our citizens are at stake. Our strategy is
    clear. We'll defend the homeland. We'll strengthen our intelligence
    services. We will transform our All-Volunteer Army--I will keep our All-
    Volunteer Army an all-volunteer army. We

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    will be relentless. We will stay on the offense. We will strike the
    terrorists abroad so we do not have to face them here in America. We
    will spread freedom and liberty. And we will prevail.
        I want to tell you--I want to talk about two quick examples of what
    I'm talking about, about spreading freedom and liberty. I want you to
    remind people, particularly the young, about what is taking place in
    Afghanistan. Three-and-a-half years ago, the Taliban ran that country
    and Al Qaida was using Afghanistan as a place to train killers, some of
    whom came and took lives here in America--3 \1/2\ years ago. Three-and-
    a-half years ago, young girls couldn't go to school because the vision
    of the Taliban was so dark. Three-and-a-half years ago, women were
    pulled in the public square and whipped if they didn't toe the
    ideological line of those ideologues of hatred. It was a grim world. And
    we acted to defend ourselves.
        Remember, I set out a doctrine--and when the American President
    speaks, the American President better mean what he says. And I said,
    ``If you harbor a terrorist, you're just as guilty as the terrorists.''
    And I meant what I said. And we removed the Taliban for our own
    security. But because we did, millions of citizens of Afghanistan voted
    in the Presidential election that took place a couple of weeks ago. The
    first voter in the Presidential election was a 19-year-old
    woman. Afghanistan has gone from darkness to
    light because freedom is on the march. And America is better off for it.
    Free nations will be an ally on the war on terror. Free nations will
    serve as a great example for others.
        Iraq will have Presidential elections in January. Think about how
    far that society has come. It's gone from torture chambers and mass
    graves to elections. Freedom is on the march.
        One of my friends--one of our friends--Laura
    and my friends in the world is Prime Minister Koizumi of Japan. That probably doesn't sound like much--so
    what. Well, let me tell you what the ``so what'' is. It wasn't all that
    long ago that we were at war with the Japanese. It's an eternity if
    you're 58 years old, but really, in the march of history it wasn't all
    that long. And after we won the war against the Japanese--and it was a
    brutal war; my dad fought there; your dads
    and granddads fought there as well--Harry S. Truman believed in the
    power of liberty to transform an enemy into an ally.
        There was a lot of people that were skeptical about that. A lot of
    people said, ``Why do we want to care about an enemy?'' or, ``This enemy
    can't conceivably become an democracy. Why should we pay attention to
    somebody who--some country that killed a lot of our citizens?''
        But there was great faith in the power of liberty to transform.
    That's what I believe. I believe in the power of liberty to transform
    societies. And as a result of that belief, I sit down with Prime
    Minister Koizumi, talking about how to
    achieve the peace we all want, talking about tough problems in the world
    so we can make a better world for our children and our grandchildren.
        Someday, an American President will sit down with a duly elected
    leader from Iraq, talking about the peace in the Middle East. And our
    children and our grandchildren will be better off for it.
        I believe in the power of liberty. I believe that people in the
    Middle East want to be free. I believe women in the Middle East long to
    live in a free society. I believe mothers and dads in the Middle East
    want to raise their children in a free and peaceful world. I believe all
    these things because freedom is not America's gift to the world; freedom
    is the Almighty God's gift to each man and woman in this world.
        Over the past nearly 4 years, we've done a lot of hard work
    together. We climbed the mountain, and we see the valley below. The
    valley below is of a more peaceful world, of a hopeful America. You
    know, when I campaigned in your State in 2000,

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    I said if you gave me the chance to serve, I would uphold the honor and
    the dignity of the office. With your help, I will do so for 4 more
    years.
        Thanks for coming. God bless. Thank you all. I appreciate your
    coming.

    Note: The President spoke at 1:37 p.m. at the United Sports Training
    Center. In his remarks, he referred to Alan Novak, chairman, Republican
    State Committee of Pennsylvania; and Prime Minister Junichiro Koizumi of
    Japan.